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Full text of "Navy Department BUMED News Letter Vol. 3, No. 5, March 3, 1944"

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R.est-ricl-ed 




NAVY DBPABJrMBNT 



3313^ 




m 



a digest of t±melt^ inform a t i on 



EDITORS 



Captain W. W. Hall, (mc) u. s. n. 
CoMDR. F. R. Bailey, (mc) u. s. n. r. 



Vol. 3 



Friday, March 3, 1944 



No. 5 



TART,E OF CONTENTS 



Filariasis 1 

Rubber Gloves, Powder for 4 

Parenteral Protein Administration... 4 

Oral Vaccines for Colds 7 

Venereal Diseases, Chemotherapy... 8 
Sulfonamide Fastness, H^st Factor... 8 

Plague, Chemotherapy of 8 

Bacillary Dysentery 9 



Water and Food Rationing, Rafts... 10 
Naval Prisoners, Rehabilitation ...13 

Flight Surgeons, Need for. 14 

Public Health Report 14 

Teaching Films, Hospital Corps... 15 

New Medical Films 16 

Special Clothing Allowances 19 



Form Letters : 

Penicillin Therapy of Gonococcus Infections, Modification of.... BuMed 21 

U.S. Naval Medical Research Unit No. 1, Redesignation of SecNav .22 

Instructions for Granting Pratique- Cristobal and Balboa OpNav .22 

Damaged Health Records, Disposition of BuMed 24 

Health Records, Disposition of BuMed 24 

Prescription for Lenses to be Entered in Health Record BuMed 26 

Revision of Weekly Hospital Report of Patients BuMed 26 



Filariasis : The occurrence of an epidemic of filariasis in naval personnel 
stationed in the Samoan area has aroused considerable interest and, to a certain 
extent, created apprehension. 

For forty years we have maintained a naval station in American Samoa, and 
yet not a single case of filariasis had been reported in naval personnel previous 
to the present war. Soon after the wartime increase of our military 
forces in Samoa, a considerable numb e r of men stationed there 
began to manifest transient swellings of the extremities, a 



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so-called ''retrograde" lymphangitis. There were also signs of involvement 
of the lymphatics of the spermatic cord and scrotum. The attendant pain and 
disability were not great, but many were fearful that the dreaded end-result, 
elephantiasis, might ensue. 

A major controversy revolved around the diagnosis. Blood examinations 
failed to reveal microfilaria, and the fact that filariasis previously had not 
been encountered in presumably similarly exposed military personnel, gave 
rise to considerable skepticism as to whether or not this disease was filariasis. 
Subsequent demonstration of adult filarial worms in involved tissues of patients 
showing characteristic symptoms established beyond reasonable doubt the fact 
that the disease was of filarial origin. 

It was not until the issue concerning the diagnosis had been settled that a 
true appreciation of the situation was possible. A survey revealed that the 
disease was occurring in troops on Tutuila, Upolu, Wailis, Funafuti, Borabora, 
and upon occasion, in troops in the Tonga Islands. The incubation periods 
varied markedly, cases appearing any time after a month of residence 
on the islands where filariasis was endemic. Evidences of the disease in the 
majority appeared only after many months' exposure. 

A thorough survey of the situation was made to discover why filariasis had 
occurred in our personnel at this time when it had not done so before. It was 
learned that sporadic cases had, in fact, been seen in past years and had not been 
recognized as filariasis. 

In an epidemiological investigation it was found that of the several possible 
mosquito vectors, A. scutellaris . var. pseudoscutellaris . a day biter, was the 
principal if not the sole vector of importance.. Dissections of mosquitoes of 
this species caught in native villages showed a high percentage harboring infec- 
tive forms capable of transmitting the disease. On the other hand, mosquitoes 
caught a hundred or more yards distant from the native villages showed practi- 
cally no infective forms. Thus it was demonstrated that the mosquito vector of 
filariasis flies only short distances from the source of infection. The natives* 
showed a high incidence of filariasis in the form communicable to the mosquito, 
that is, with microfilaria present in the blood. It therefore became apparent 
that for transmission military personnel and natives must live in propinquity. 
Conversely, it was evident that for protection, the two important factors were 
on the one hand mosquito control and on the other separation of natives from 
military personnel. 

In the early days of the war, troops were sent to these islands in such num- 
bers that it was often impossible to quarter them at safe distances from the 
natives. Frequently the haste with which these occupational operations had to 
be carried out made it impossible to accomplish adequate mosquito control 
measures. 



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Epidemiologically it is of interest that although the disease exists in natives 
throughout both the South and Central Pacific areas, it is only in the Central 
Pacific islands that transmission has been demonstrated in military personnel. 
" The explanation apparently lies in the fact that in the South Pacific islands it 
has not been necessary to quarter troops in proximity to natives. It is also 
known that a different mosquito vector is responsible for transmission in the 
South Pacific. What this vector is remains to be determined. However, it is 
very likely that it is A. punctulatus, var. mpluceensis . Whatever the actual 
explanation, almost without exception, cases of filariasis encountered ilp to the 
present in the New Hebrides and Solomons have been in men formerly stationed 
in the Central Pacific. 

Several factors should operate to limit the further spread of the Central 
Pacific epidemic: (1) adequate mosquito control, (2) individual protective meas- 
ures against the vector, and (3) the gradual reduction of the military population 
of Samoa and the nearby islands with the northward advance of the American 
forces, allowing proper separation of military personnel and natives. It is 
evident that there need be no alarm on the part of troops who are going into areas 
where filariasis is endemic because control is possible by fairly simple meas- 
ures. The disease will not again become a menace unless a future military 
situation should enforce upon a group such extraordinary conditions have pre- 
vailed in the past on these islands. 

It is too early to predict the future course of the disease in those who have 
already contracted it. In many individuals removed from an environment where 
they are subject to repeated reinfestation, the clinical manifestations of the dis- 
ease have subsided with reasonable rapidity. Others have had a number of re- 
lapses over long periods of time even after return to the United States. It is 
well established from past experience in natives and Europeans that it 
is unusual for elephantiasis to develop except following repeated reinfestations 
over a period of many years. Furthermore, even under such conditions, ele- 
phantiasis is a rare complication in Samoan natives. Present directives require 
remov^ of patients who appear to have contracted filariasis from endemic areas 
and thus one would not expect elephantiasis to become a common sequela in such 
>? men. In view of these facts, anxiety with respect to future elephantiasis in 
military personnel who have contracted filariasis, although 
understandable, is not justified. 

Although studies are being carried out at the present time to determine the 
validity of this belief, the evidence at hand very strongly indicates that under 
any but extreme conditions the disease does not lead to any damage to the repro- 
ductive organs from a functional standpoint. Men suffering from filariasis should 
be reassured on this point, and their fears must be dissipated as to the possi- 
bility of transmission of the disease to others through sexual or other physical 
contact. 



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Although repeated blood studies have been made, there has not been a . 
single well- supported instance in which microfilaria have been demonstrated 
in blood smears from our military personnel. In the absence of blood forms 
the likelihood of introducing filariasis into areas in the United States where it 
is not now endemic seems remote, even when the mosquito vectors are abundant. 
(J.J.S.) 

sfl 5|c J^C 

Potassium Bitartrate in Place of Talcum in the Preparation of Rubber Gloves: 
It is well recognized that talcum powder when introduced into the body during sur- 
gery sets up a granulomatous, inflammatory reaction which may, especially in 
the peritoneal cavity, produce serious complications. It is difficult to remove 
all talcum powder from rubber gloves even by careful washing. 

Seelig et al recommend the use of potassium bitartrate in place of talcum 
powder in the preparation of gloves. They find that, it is harmlessly disposed of 
by the body tissues and fluids and causes no consequent peritoneal adhesions. 
There has been no evidence of irritation or undesirable skin effects on the sur- 
geon's hands. 

Potassium bitartrate tends to shorten the life of rubber -gloves. Tartrated 
gloves were found to stand from seven to ten separate sterilizations, whereas 
gloves powdered with talcum permitted from twelve to twenty. It is important, 
the authors emphasize, that potassium bitartrate be subjected to no more than 
fifteen minutes of autoclaving at fifteen pounds steam pressure. (J. A.M. A., 
Dec. 11, '43.) 

^ ^ ^ 1^ 

Parenteral Protein Administration : The importance of a constant positive 
nitrogen balance in wound healing and in resistance to infection has been well 
established by extensive clinical and laboratory study. The assumption that 
tissue protein reserves are sufficient to meet ordinary requirements has been 
proven incorrect by Weech who demonstrated that the plasma protein of dogs 
maintained on protein-poor diets began promptly to fall and continued downward 
as long as protein-deficient diets were fed. The fall was in the albumin fraction, 
the globulin fraction remaining relatively constant. In the normal fasting human, 
a nitrogen deficit rapidly appears and, if not promptly corrected, a decrease of 
plasma protein follows. Estimation of the serum protein does not always give a 
true picture of the plasma protein loss, as reduction in plasma protein may, at 
first, be accompanied by a proportionate decrease in blood volume with the amount 
of protein per unit of blood remaining constant. 

While it is generally agreed that during convalescence every effort should 
be made to maintain a positive nitrogen balance by oral feeding of protein foods, 



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there are many instances when adequate intake by this route is impossible. In 
practically all cases of severe injury o r illness and following major surgery, 
an interval of days or weeks may elapse before oral feeding of protein in ade- 
quate amounts is possible. 

Early investigators working in the field of protein metabolism determined 
the chemical structure of amino acids and established their biochemical role 
as the building stones of protein. Subsequent investigation has indicated that 
there are ten amino acids essential to life and growth and the synthesis of these 
amino acids has been accomplished. More recent work has shown that when 
amino acids in proper mixture are administered orally or parenterally, synthe- 
sis to blood and tissue protein occurs, and, when given in adequate quantity, 
positive nitrogen balance results. 

Elman, in 1939, first administered to humans an amino-acid mixture obtained 
by the acid hydrolysis of casein. This mixture was found deficient in one of the 
essential amino acids, tryptophane, which is apparently unstable and is destroyed 
by this method of hydrolysis. All the essential amino acids plus some of those 
which may be synthesized by the body (non-essential), along with polypeptides, 
are contained in the enzymatic hydrolysates of casein. An enzymatic hydrolysate 
of casein and pork pancreas produced by Mead Johnson and Company (Ajnigen) , 
has been used extensively in experimental and clinical work, and, at present, is 
the only preparation available in quantity which is well utilized and will maintain 
nitrogen balance. 

The pure crystalline amino acids have been produced in small quantity for 
experimental study. These substances are chemically pure and thus can be used 
in variable proportions, a point which may eventually prove to be of advantage 
in meeting certain specific amino-acid requirements. The crystalline amino 
acids may be injected in higher concentration and at a more rapid rate than 
casein hydrolysate, thus facilitating the administration of the desired amounts 
in brief injections of one to two hours' duration. Plasmapheresis experiments 
by Whipple also indicate that a mixture of crystalline amino acids (Rose's mixture 
plus glycine) produces a higher rate of plasma regeneration than the hydrolysates. 
Although these advantages would appear to establish the crystalline amino-acid 
mixtures as the preparations- of choice for parenteral nitrogen administration, 
these substances cannot now be produced in sufficient quantity for general clinical 
use. 

Nitrogen-balance studies have been made in cormection with many abnormal 
conditions, and large deficits have frequently been observed. 

The nitrogen loss in severe burns is often as much as- 30 Gm. per day. A 
total protein deficit of 2,000 Gm. occurring in one severely burned patient re- 
quired the administration of 6,000 Gm. of protein before nitrogen balance was 
attained, plasma protein regenerated and clinical edema relieved. 



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Following major surgical procedures, 20, to 25 Gm. of nitrogen may be 
lost per day for a variable period of time. Gastrointestinal surgery attended 
by dietary restriction over an extended period of time gives rise to large pro- 
tein deficiencies. Nitrogen deficits are frequently observed in cases of peptic 
ulcer when accompanied by impaired ingestion, obstruction or hemorrhage, in 
severe colitis and in malignancies of the gastrointestinal tract. 

Severe wounds and fractures are accompanied by nitrogen deficits of vary- 
ing degrees related to the amount of tissue destruction, and loss of blood and 
plasma. Post -operative wound disruption has been found to occur more fre- 
quently in patients as well as in laboratory animals having low plasma proteins. 

Whipple has found that when hemorrhage has occurred, the regeneration of 
plasma proteins is retarded. He believes this to be due to a priority which the 
regeneration of hemoglobin appears to have on available protein. Hence, primary 
attention must be given to the rapid return of hemoglobin to normal levels, by 
repeated transfusions if necessary, before satisfactory plasma regeneration and 
nitrogen balance can be expected. 

•Recent observations attach increased importance to the .maintenance of 
nitrogen bailee in combating infection. Nitrogen deficits of varying degree 
relative to the severity of the infectious processes have been observed. Further 
study of amino acids may reveal specific combinations of these units as most 
efficacious in the formation of antibody factors. The action of the chemothera- 
peutic agents, the sulfonamides and penicillin, has been observed to be enhanced 
by the maintenance of nitrogen balance. Thus the desirability of optimum pro- 
tein intake during infections extends the field of application of amino-acid prepa- 
rations to many serious, acute and chronic surgical and medical conditions, in 
which an adequate amount of protein cannot be taken orally. 

The exact protein requirement of a patient can be calculated by determining 
the nitrogen balance. As this requires quantitative determination of total nitro- 
gen output, it is not practicable for general clinical application. For practical 
purposes several simple principles permit a satisfactory approximation of the 
amount of protein required. 

To arrive at this approximation one must have knowledge of (1) the physical 
condition of the patient, (2) the past dietary history, (3) the severity of the injury 
or disease with respect to protein loss and destruction, (4) the patient's normal 
daily protein requirement calculated on the basis of one gram of protein per 
kilogram of body weight. 

As previously indicated, the nitrogen loss in the urine alone 
may be as much as 30 grams per day. In terms of protein loss this amounts to 
6.5 X 30 or 195 Gm. Hence, the protein required for an individual patient whose 
normal weight is 70 Kg. will range from 70 Gm. to 200 Gm. The amount to be 



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administered, selected from within this range, may then be decided on the basis 
of such knowledge as indicated above. 

When the approximate protein requirement has been thus estimated the 
amount of amino acid substance to be administered parenterally may easily be 
calculated by subtracting from the total requirement the' whole protein which the 
patient is able to utilize by the- oral route. The balance is the amoimt to be 
supplied as amino acids. For practical purposes one gram of amino acid sub- 
stance (Amigen) may be regarded as equivalent to one gram of protein. 

In order that the protein administered may be used entirely for regeneration 
of blood and tissue protein, it is necessary to meet the patient's basal caloric 
requirements with glucose. However, Elman has found that, in the well nourished 
individual, nitrogen balance can be maintained and ketosis prevented, upon ad- 
ministration of amino acids when as little as 25 per cent of the basal require- 
ment is covered with dextrose, the remaining 75 per cent being supplied by ca- . 
tabolism of body fat. 

Administration of such mixtures parenterally may be by separate multiple 
injections at convenient intervals or by continuous intravenous drip during the 
24-hour period. 

No serious nor anaphylactic reactions due to amino-acid preprations have 
been reported. The most frequent reactions observed are flushing, headache, 
nausea and vomiting. These reactions are related to the speed of injection and 
occur at slower rates of injection of the hydrolysates than of the crystalline 
amino acids. It is believed that certain non-essential amino acids contained in 
the hydrolysate may be responsible for these reactions. These are not serious 
reactions and are promptly relieved by slowing the rate of injection. 

The procurement of the enzymatic hydrolysate of casein (Amigen-Mead 
Johnson and Company) has been recommended. It is hoped that an announcement 
of the availability of this item may soon be made. A letter of information and 
instruction is planned for publication at the time of this announcement. (J.F.C.) 

* + + * + * 

Oral Vaccines for Colds: "Recent communications to the offices of the 
American Medical Association indicate that the prescription and sale (oral) cold 
vaccines is again taking place on a large scale. This, in the face of the recog- 
nized lack of scientific evidence for the value of these preparations, is indication 
of irresponsibility on the part of some manufacturers of pharmaceuticals. The 
scientific 'evidence against the value of oral cold vaccines is overwhelming; conse- 
quently, individual physicians and firms who deal in pharmaceuticals and who lend 
themselves to wholesale uncontrolled distribution of such preparations are perpe- 
trating an unwarranted commercial assault on the public pocketbook." (Current 
Comment, J. A.M. A., Jan. 22, '44.) 



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Chemotherapy of Venereal Diseases : Commander A. J. Pereyra CMC), 
USNR, working with Senior Surgeon J., F. Mahoney, U.S.P.H.S., at the U. S. 
Marine Hospital; Staten Island, N. Y., reports that penicillin produces satis- 
factory healing in the lesions of granuloma inguinale. 

In scrapings from the ulcerations on the external genitals and adjacent skin 
of patients with this disease, macrophages can be found, containing numerous 
small bacillij Klebsiella granulomatis . These organisms, first described by 
Donovan, and therefore sometimes called Donovan bodies, are Gram -negative, 
encapsulated, oval and diplococcoid, can be cultivated readily on Sabouraud's 
and other media, and in cultures resemble the Friedlander bacillus. Although 
these -organisms are almost always present in granuloma inguinale, it is possible 
that they are secondary invaders rather than the primary cause of the disease. 

It has not been determined whether or not this favorable effect of penicillin 
is brought about by its action on the Klebsiella granulomatis per se. 

On the other hand, in Commander Pereyra's experience penicillin has been 
of value neither in the treatment of lymphogranuloma inguinale (lymphopathia 
venereum) , nor in the treatment of chancroid. 

Host Factor in Clinical Sulfonamide-Fastness: Mahoney reports that human 
volunteers have been inoculated with pure cultures of gonococci. A discovery of 
great interest is that when a number of men are inoculated with the same strain, 
the organisms in one individual may be sulfonamide-resistant and in another 
sulfonamide -susceptible. Apparently there is a host -factor to be reckoned with 
in clinical sulfonamide -fastness, and clinical resistance to the drug does not de- 
pend solely upon changes in growth characteristics of the organisms demonstrable 
in vitro. 

jf; + 3)c 5(! i(t :)£ 

Chemotherapy of Plague : The efficacy of sulfonamides in mice artificially 
infected with plague has been demonstrated by Meyer (M. Clin. North America, 
May '43.). Sulfadiazine and sulfathiazole were found to be most effective. 
The necessity for the' institution of early therapy was demonstrated 
by the fact that mice treated at the time of the appearance of symptoms 
recovered, while those in which treatment was delayed died. Animals treated 
for only five days appeared at first to recover but relapsed and died about 20 
days later of plague pneumonia; those survived which were treated for 10 days 
after subsidence of symptoms . Many animals treated with the sulfonamides 
were culturally negative, but died with lesions microscopically typical of plague. 
This might be taken' as an indication that serum should be used in conjunction 
with sulfonamide therapy. 



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According to recent reports from India the case fatality rate in 147 cases 
of plague was reduced to 22.4 per cent in the bubonic cases and 41.9 per cent 
in the septicemic cases when patients were treated early and intensively with 
sulf athiazole . The mortality in the controls treated with iodine intravenously 
was 53.6 per cent in the cases of bubonic plague and 90.8' per cent in cases 
with plague septicemia. 

In Madagascar, Meyer reports that Girard cured 15 out of 19 adults treated 
with sulfapyridine or sulfanilamide. In fact of a total of 37 patients with bubonic 
plague receiving these drugs with or without serum, only nine died, making a 
recovery rate of 76 per cent. Both experimental and clinical experiences, how- 
ever, suggest a continuation of treatment on doses of from 1 to 2 Gm. for at 
least 12 days after the fall of the temperature. There is unanimity in the belief 
that early and intensive treatment alone effected the' cures thus far reported. 
The effect of treatment by serum combined with sulfonamides is still under trial, 
but in Girard's experiments on guinea pigs treatment by serum and sulfapyridine 
showed no superiority over the drug alone. 

At a recent meeting of the Subcommittee on Tropical Diseases of the National 
Research Council, Meyer reported the following two cases: A 2-1/2 year old 
girl with plague was given sulfadiazine for a total of 16 days. A week after treat- 
ment was stopped, she developed a temperature of 105°, and quickly died of 
plague meningitis. A second case of plague in a boy 11 years old was reported. 
Sulfadiazine in dosage of 3.5 Gm. was given every 6 hours for 5 days, producing 
a blood level of 8 to 10 mg. per 100 c.c. of whole blood. Subsequently, sulfa- 
diazine (2.0 Gm.) was given every 6 hours for 14 days, the drug being continued 
for 10 days after the temperature became normal. The patient received 50 c.c. 
of sheep antiplague serum on the fifth and sixth days. Recovery was complete 
and uneventful, with rapid resolution of enlarged and suppurating axillary lymph 
nodes. (F.T.N.) 

5^C ?(5 5|C 5|C SfC 3|C 

Proper Terminology in Bacillarv Dysentery. Many times during this war 
there have been explosive outbreaks of dysentery among troops. Although many 
of these epidemics have clinically resembled bacillary dysentery, the lack of 
bacteriological facilities under combat conditions has usually prevented the 
determination of the specific causative organisms. The official diagnostic nomen- 
clature of the Navy contains for this disease only the heading Dysentery . Bacillary , 
#901, but it is of considerable importance to record in the health record the strain 
with which the individual is infected. If one of the more virulent strains is recorded 
or if the carrier state should develop, the patient would be treated differently during 
recurrences. In view of the wide variations in virulence exhibited by the various 
strains, the epidemiological importance of properly recording such data is obvi- 
ous. The present terminology was adopted within recent years in an attempt to 
simplify a previously confused nomenclature. In this calssification the most 



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virulent and dreaded strain, commonly designated as ''Shiga", is properly termed. 
''Shigella Dysenteriae." Bacteriologically this bacillus is characterized by its 
inability to produce acid in mannite broth. The remaining organisms, sometimes 
called the "Paradysentery group", are properly recorded as follows: "Shigella 
flexneri", "Shigella sonnei", "Shigella ambiguus", "Shigella newcastle", 
"Shigella alkalescens", and "Shigella dispar." 

Chemotherapy of Bacillarv Dysentery: On the basis of data then available, 
the National Research Council in January 1942, recommended sulfaguanidine in the 
treatment of bacillary dysentery. Subsequent studies have shown that this drug 
is so insoluble as to be largely therapeutically inert, many cases having as much 
as nine-tenths of the drug contained in the bowel in crystalline form. The absorb- 
able sulfonamides are much to be preferred, sulfadiazine being the first choice, 
with sulfathiazole as second. The recommended dosage of sulfadiazine or sulfa- 
thiazole is 2.0 Gm. initially, with 1.0 Gm. every 6 hours until symptoms have 
subsided, or until two successive stool cultures have been negative. The Flexner 
strain is so sensitive to these drugs that the dosage may be reduced to half of 
that recommended above. The Sonne strain frequently develops resistance to 
other sulfonamides to a greater extent than to sulfasuxidine. A change to this 
drug is desirable if poor results have been obtained after a week of treatment 
with another sulfonamide. (F.T.N.) 

Rationing of Water and Food bv Shipwrecked personnel : It is expected that 
in the next few weeks the Bureau of Medicine and Surgery will present, in such 
generally circulated Navy publications as the Naval Aviation News, instructions 
regarding the rationing of food and water on lifeboats, rafts and floats. The 
following paragraphs summarize these instructions and the information on which 
they are based. The instructions presented here are those specifically for sur- 
vivors on inflatable life rafts; they are, however, applicable in all respects to 
lifeboats and drum-type rafts. 

Summary of advice dealing with water : 

1. Be sure you take a drink of water before starting off on a mission. 

2. Unless it is immediately obvious that the procedures will make you cold, 
if forced down, conserve body water by the following measures, which should be 
temporarily discontinued when they result in sensations of chilliness: 

a. Perform no unnecessary exertion. 

b. Remove, but do not discard, all clothes save those necessary to 

protect you from sunburn. Unbutton the front of your shirt. 

c. Expose your body thus clothed to the breeze as much as possible. 

d. If you' can, rig an awning protecting you from the sun but not 

interfering with the breeze. 

e. Keep your clothes constantly wet with sea water during the day .. 

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S. tinless yen hmotm- thirsty, drink no water for the first 24 hours on 
the raft. 

4. Thereafter, drink one pint (16 ounces) of water a day if your supply is 
limited; drtak a pint and one-half (24 ounces) a day, or more if necessary, if 
you half© an abundant supply of rain water and the one pint allowance does not 
satisfy your thirst. 

5. When you have only about 10 ounces of water left,, it merely tp jpaois- 
ten your mouth and sip until rain is encountered. 

6. In the event of rain, when you have been on a very limited ration of water, 
drink, your fill slowly over the course of about 1 heui"! ntxt dsti?' rsturii to fom 
usual daily allotnient of one pint. . ' 

g^mmary of advice dealing; with solid food: 

1. Eat daily approximately the amount recommended for the particular' 
ration with which you are supplied. 

2. The flesh and entrails of fish, turtles and birds are valuable foods; but 
do not eat them in large quantities unless you have an abundance of water. 

3. If your ration of water is less than one and one-half pints a day, eat only 
small' quantities of flesh - say 10 one-inch cubes, equal to 5 ounces, daily. If 
the fish is a shark or dogfish, eat only 4 such cubes a day. If your water ration 
is very small or if you have no water, you may find that even these small amounts 
of fish or bird flesh may increase your thirst, in which case you should not eat 
them at all. 

4. Eat no dried flesh or entrails unless you are drinking a quart (32 ounces) 
of water a day. Reduce the amount eaten if it makes you persistently thirsty. 

Fish flesh should be regarded not as a source of water but a solid 

foM. 

* * 

The rationale of the measures used to reduce evaporative water loss to 
a minimum was discussed in the Burned News Letter of January 7, 1944. It was 
pointed out that each day 1,500 c.c. or more of body water can be lost unneces- 
sarily during calms In tropical waters bieeause of ea^ess evaporation of water 
from the skin; these losses are insidious in that they may occur even tteough s© 
sweat is observed on the skin. 

Experiments on subjects on pneumatic life rafts conducted by the Naval 
Medical ReseiJ?ch Institute have substantiated laboratory evidence that when 
the evaporative water loss of semi-fasting men is maintained at a minimum, 
the daily requirement of water lies between 500 and 1,000 c.c. The 710 c.c. - 
(24 ounce) figure was taken arbitrarily as a convenient average; 16 ounces is 
TW^atim& a» an mtesQlmt©- mlniiEpea ajid is litelF to in-saffiisieat t®. m^mtB.m 
completely hydration in some 1211% The water balance of fasting men may be 
stated roughly as follows: avaitaloia to boflg. 71Q c.c. as drinking wate^r^md 



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300 c.c. as water freed from tissue as it is being consumed and water derived 
from subsequent oxidation of that tissue; lost from body . 450 c.c. as urine, and 
750 c.c. as water, unavoidably evaporated from lungs and skin. It is not harm- 
ful if the balance is slightly negative, since the body is consuming its tissue 
and can dispense with the water formerly incorporated in that tissue. 

If a man has been afforded a chance to drink his fill of water a short while 
before abandoning ship, part of the water drunk during the ensuing 24 hours will 
be wasted as relatively dilute urine. On the other hand, dehydrated subjects can 
drink large quantities of water (from rain, for example) without subsequently 
wasting a significant amount of it as urine. When the supply of water is very 
limited, it seems wiser to maintain maximum strength as long as possible and 
to issue the extreme minimum requirement (16 ounces) daily until only 10 ounces 
is left, rather than to issue smaller amounts over a longer period of time. 

Within the next few months a chemical kit for de mineralizing sea water, 
produced by the Permutit Company in collaboration with the Naval Medical Re- 
search Institute, will be placed in the Bureau of Aeronautics life rafts; it will 
increase by about nine times the amount of water available per unit volume of 
storage space. The use of sea water to dilute fresh water has not been demon- 
strated to offer any significant benefit. The procedure is not recommended. 
The use of undiluted sea water by mouth or rectum is of course contraindicated. 

The Bureau of Ships life floats are at present stocked with a solid ration 
of canned luncheon meat, biscuits, and malted milk. There is evidence that this 
is not a satisfactory emergency ration. The Bureau of Aeronautics is now pro- 
curing the new Naval Medical Research Institute Tablet Emergency Ration. This 
ration is composed of high fat butterscotch and hard candy tablets (both of which 
contain citric acid), malted milk tablets, multiple vitamin tablets and chewing 
gum. This ration is 84 per cent carbohydrate and 12 per cent fat. In the Bumed 
News Letter for June 11, 1943, it was indicated that such a combination produces 
a ration which is palatable in the presence of thirst and which, since it is low in 
protein, does not create significant amounts of urea which requires water for 
excretion. Dr. A. M. Butler of the Harvard Medical School has demonstrated 
that the inclusion of fat in a candy renders it less nauseating. He has shown also 
that fasting volunteers drinking 400 c.c. of water a day lose less weight and less 
body water and are more vigorous when to their regime is added 50 Gm. of 
sugar and 50 of fat than when the addition consists of 100 Gm. of water. These 
findings indicate that the most satisfactory ration for survivors is one consisting 
of 100 Gm. daily of a mixture of carbohydrate and fat; Dr. Butler favors a special 
high fat butterscotch candy for this purpose. 

Experiments conducted by Dr. J. P. Peters of the Yale Medical School, in 
cooperation with the Wright Field Aero-Medical Laboratory, demonstrated that 
fish flesh contains barely enough water, possibly not quite enough, to carry away 
in the urine the metabolic products of the fish protein. Therefore, while fish 



- 12 - 



Burned Mews Letter, Vol. 3, Ho. 5 



and birds are valuable food, they should be eaten only in small amounts when 
the intake of water is limited. Since dried flesh makes even less of a contri- 
bution of water, it should not be eaten unless water is abundant. 

The majority of those who have reported their attempts to wring or squeeze 
'Vater" out of fish have been unsuccessful. Mechanical presses are required 
to express tissue juice from fish; the content of salt and protein of juices ex- 
pressed by some presses Is so high as to render them of questionable value to 
the body as sources of water. Fish is not to be regarded as a source of water. 

The inclusion of scopolamine in 0.6 mg. Cgr. 1/100) tablets in the first-aid 
kits of life rafts of vessels and aircraft was reported in the Burned News Letter 
of October IB, 1943. Seasickness may increase the water lost by survivors mM 
may interfere with the operating of raft paraphernalia, such as signaling devices. 
Personnel should be instructed that, if shipwrecked, they should immediately 
examine their raft's first-aid kit to ascertain whether it contains a preventive 
of sea^iGkness, One of the tablets shduld be swallowed if the water is rough. 
Subsequently, the tablets should not be taken more often than every 6 hours . 
After the first 24 to 48 hours, acclimatization to the motion of the raft will proba- 
bly occur and further use of the tablets will not be necessary. If morphine has 
been administered, then scopolamine should not be tten until about 24 hours 
hwe |@ssed> CP.H.F.;.W.V.C.; N.P.) 

****** 

The Portsmouth Naval Prison - Rehabilitation : The success of the recla- 
mation program at the Portsmouth Naval Prison under the direction of Commander 
Thomas H. Pargen CMC) , USNR, is shown by the fact that 86 per cent of its in- 
mates annually are rehabilitated and returned to active duty. 

Prisoners arriving at Portsmouth are first subjected to a painstaking psy- 
chiatric appraisal in an effort to find, and if possible eradicate, the maladjust- 
ments underlying their offenses. Aptitude studies have proved useful in placing 
men at crafts which they like and in which they show ability. Machine, carpenter, 
electrical, plumbing and paint shops are available for vocational training. There 
are possibilities also for work in welding, wireless operating, tailoring, shoe- 
making, bookbinding, laundering, cooking, etc. Men who continue to show skill 
and interest in their work may be given advanced instruction in schools of techni- 
cal training, among which are the radio, electrical, signaling and seamanship 
schools. In the average case a third of the sentence is revoked for good conduct. 

An innovation that has shown most gratifying results is the establishment of 
the iSpecial Honor Company, composed of men who have less than two months to 
serve before being restored. The men of this company are picked competitively, 

that is, by their work records, conduct, neatness, smartness in drill, application 
in class, etc. This company has done much to establish self-confidence and self- 
respect among its members and has made a major contribution towards improving 
the general morale. 



- 13 - 



Burned News Letter, Vol. 3, No. 5 



The Honor Company is housed by itself in a barracks on a separate part of 
the reservation. The young Marine Officer, whose part in the Rehabilitation 
Program is acting as Commanding Officer of this company, lives in the barracks 
with them. The entire routine is the exact counterpart of barrack life anywhere 
in the Service. The men wear blue undress jumpers with their gray trousers, 
which distinguish them from all the rest. They salute officers, mount guard, etc. 
The ''esprit de corps" is of the highest. 

Need for Medical Officers of Regular Service as Flight Surgeons : The tre- 
mendous expansion in the carrier building program and the increase in size and 
number of shore establishments of the aeronautical organization has placed a 
heavy demand upon the Bureau for flight surgeons of administrative rank (lieu- 
tenant commanders and commanders, regular Service), for assignment as senior 
medical officers to the larger aircraft carriers and to administrative positions 
ashore. To meet these requirements the Bureau is anxious to assign such officers 
to training in aviation medicine at the earliest date practicable. 

In general it will be the policy to assign Reserve Medical Officers of ad- 
ministrative rank already qualified as flight surgeons or aviation medical exam- 
iners to the smaller carriers as senior medical officers and to other administrative 
duties commensurate with their naval experience. 

Interested officers should submit to the Chief of the Bureau of Medicine and 
Surgery letters of application requesting training in aviation medicine. CW.J.C.A.) 

3|c ^ 3^ Sjt j|c 



Public Health Report: < 
Disease Place Date Number of Cases 



Belgian Congo 


Nov. 


20- 


■27, '43 


8 (7 fatal) 




Nov. 


27- 


-Dec. 4, '43 


2 (2 fatal) 


British East Africa 










Kenya 


Dec. 


4- 


-11, '43 


1 (1 fatal) 


Ecuador, Loja Prov. 


Nov. 


1- 


■15, '43 


1 (1 fatal) 


Egypt, Suez 


Nov. 


13- 


-20, '43 


12 (4 fatal) 


Nov. 


20- 


-27, '43 


7 (3 fatal) 




Nov. 


27- 


■Dec. 4, '43 


10 (8 fatal) 




Dec. 


4- 


■11, '43 


15 (12 fatal) 



- 14 - 



Burned News Letter, Vol. 3, No. 5 



Piitolie Health Report: (cont.) 



Disease 
Plague 



Place 



Smallpox 



Pate 



Egypt, Suez (cont.) Dec. 11-18, '43 

Dec. 19-22, '43 



Hawaii, T. H, 
Madagascar 

Algeria 
Morocco (Fr.) 



Year 1943 
November 1943 

Nov. 1-10, '43 
October 1943 



Number of Cases 

39 (27 fatal) 

11 
7 (fatal) 
2 (2 fatal) 

102 
5.8 



Typhus S'evei* 



Yellow J'ever 



Ecuadfjr 


NOV. 1-i©, 40 


y 


iiungary 


rior- 4.-1 1 '4^ 


1 Q 


Morocco (Fr.) 


October 1943 


53 


Rumania 


Dec. 8-15,. '43 


152 


Slovakia 


Nov. 20-27, '43 


15 




Nov. 27-Dec. 4, '43 


15 


Spain 


Oct, 31 -Nov. 6, '43 


9 


Trinidad 






Port- of -Spain 


Sept. 16-30, '43 


1 


Colombia 


Nov. 21-Dec. 11, '43 


13 (fatal) 


Gold Coast 






Tamale 


Nov. 23, '43 


1 (suspected) 


Portuguese 






Guinea 


Dec. 18-25, '43 


3+ 


Senegal 


Nov. 13, '43 


1 




Nov. 11-20, '43 


1 (fatal) 


Sierra Leone 






Gallinas 


Dec. 1, '43 


1 (fatal) 






1 (suspected) 



(Pub. Health Rep., Jan. 14, 21, '44.) 

5|c s(c !)? 3je !je ;jt 

Teaching Films for Hospital Corpsmen: Under the general title, CARE 
OFMim AND INTIJRED BY MPTTAT, CxmP^^MIlM. BuMed is producing a - 
series of sound motion pictures (MN-1511~(a) to (j)) showing the proper technic 
of the more common nursing procedures. These films, of which eight. are now 
available, should be seen by all Hospital Corpsmen and used as an integral part 
of their tminti^ prograia* . 

jjt ^ 9|c ?jc Sfc 



- 15 - 



Burned News Letter, Vol, 3, No. 5 



RESTRICTED 



Supplemental List of Medical f'ilms : A new catalog of medical films has 
just been distributed. Copies are available on request to BuMed. The following 
new films are now available: (See Bumed News Letter, May 28 and September 17, 
1943, for lists of other films.) 

MN-2361 G and You (Color - 50 min.) Confidential. 

MN-2396 a&b Physical Examination for Navy Flying Personnel (B & W - 31 

min.) The technic of Physical Examination for Navy Flying 
Personnel is depicted in detail. This film is a revision of an 
Army film on the same subject. 



MA- 3273 



First Aid for Chemical Casualties (B & W - 18 min.) This 
film is intended for basic indoctrination of all Army personnel 
in First Aid for Gas Casualties. It should serve the same 
purpose for Navy personnel. This film replaces "First Aid 
for Gas Casualties" (MA- 1241). 



MN-2479 



SN-2204 



MN-2153a 



MN-2617 



MN-2222e 



Factors Concerned in the Construction of Full Mandibular 
and Maxillary Dentures (Color - 40 min.) By actual photog- 
raphy the exact technic of taking impressions for dentures 
for a completely edentulous patient is shown. 

Radiodontics (Sound - 39 Frames - 20 min.) The X-ray 
appearance of the common tooth changes are shown and de- 
scribed in detail. The value of the X-ray to the Dental Officer 
is emphasized. Of interest to all Dental Officers. 

Evaluation of Physical Fitness by the Step-Up Test (B & W - 
20 min.) The technic of performing the Step-Up Test for 
physical fitness is shown in detail by actual photography and 
the necessary calculations are described. 

Life Cycle of Endamoeba Histolytica (Color- Silent- 15 min.) 
By means of animation, the life cycle of the Endamoeba Histo- 
lytica and the pathological changes which it produces in the 
human body are shown. 

Pick Your Chances (Formerly Called "Sick Bay") (B & W - 
30 min.) This film is, one of a series of films designed for 
Boot Training. It impresses the enlisted man with the ne- 
cessity of promptly reporting any injury or illness to the 
Medical Officer, It should be seen by all enlisted personnel ■ 
as soon after entering the Navy as possible. 



- 16 - 



Burned News Letter, Vol. 3, No. 5 



MN-1511 

MN-I&lll) 

MN-1511G 
MN-1511d 



MN-1511e 
MN-1511g 

MN-1511i 



MN-1511j 



MN-1509 



MN*17X2a 



Care of the Sick and Injured by Hospital Corpsmen (B & W) 
This series of films was produced specifically for the instruc- 
tion of Hospital Corpsmen in nursing procedures and technics. 

Morning Care (7 mm). Dejitete iHm ^OMm oi a BD^iteJ. Corps- ' 
man in the morninf eare of patients on a hospital ward or sick 
bay. 

.Bathing the Bed Patient. (19 -min.) .Depicts the technic ol giving 
bed patients a bath and technic of making the bed. 

Beds and Appliances (10 min.) Depicts the various beds and 
appliances commonly used in-sick bay and hospital ward care 
of patients. Technic for making a bed and bunk is shown in 
detail. 

Evening Care (7 min.) Depicts the technic of giving a back rub 
and the routine evening care of hospiMl ©r ©ick bay patient. 

Taking a Blood Pressure (7 min.) Depicts the technic of taking 
and recording blood pressure. 

Post-Operative Care (12 min.) The essential points in the 
post-operative care of patients are shown. 

TTOp«ratur@,-:^ui0®> <an4Be%slralion C^^ The e±aet 

technic for taking temperature, pulse and respiration on a 
single patient and on a number of patients in a ward is shown. 
The method of charting temperature, pulse and respiration 
Is also shown. 

Oral Medications (7-1/2 min.) The proper technic of giving 
and charting medications prescribed for hospital or sick bay 
patients and the recording of the medications is shown. 

Bluejackets' Personal Hygiene (B & W - 20 min.) A review 
of the basic principles of personal hygiene. Of general interest 
to all male naval personnel. 

Personal Hygiene for Women (Restripted) Part I (B & W - 44 
min.) Depicts the general measures necessary to insure good 
health, including a balanced routine of sleep, exercise and re- 
laxation- High standards of personal cleanlines® and goSd 
grooming are emphasized. By means of animated sequences, 
the anatomy and physiology of the female reproductive organs 
are shown. This film should be seen by all WAVE personnel. 



- 17 * 



Burned News Letter, Vol. 3, No. 5 



RESTRICTED 



MN-1712b Personal Hygiene for Women (Restricted) Part II (B & W - 

32 min.) This film depicts the hygienic measures necessary 
to prevent the spread of contagious diseases. A portion of 
the film is devoted to venereal disease. This film should be 
seen by all WAVE personnel. 

MA-2689 Purification of Water (B & W - 19 min.) The purification of 

water by the accepted field methods is depicted in detail. 
This film is of interest to all Advance Base personnel. 

MA- 2820 Military Sanitation - Disposal of Human Waste (B & W - 18 min.) 

The correct sanitary measures for the disposal of human waste 
at Advance Bases is shown. Of interest to all Advance Base 
personnel. 

SN-1934 Musca Domestica - The Fly (Field Sanitation Series) (68 frames 

with sound - 7 min.) By drawings, the spread of filth and dis- 
ease by the house fly is vividly depicted. It is not a technical 
film and is of interest to all personnel. Useful for indoctrina- 
tion in Field Sanitation. 

MN-1724b Skeletal Fixation by the Stader Splint - Fractures of the Os 

Calcis (B & W - 10 min.) The technic of the application of the 
Stader Splint for a fracture of the os calcis and the necessary 
pre-operative and post-operative care is depicted. An anima- 
tion sequence shows the displacement which occurs in a fracture 
of the OS calcis and the steps necessary for the reduction of 
such fractures. 

MN-1901 Skeletal Fixation for Fractures of the Mandible (Color - 10 min.) 

The technic of application of the Roger Anderson Splint for 
fractures of the mandible is shown. 



MN-247Y Eye Surgery - Treatment for Paresis of the Superior Oblique 

(Color- Silent- 7 min.) The technic of the operation for advance- 
ment of the superior oblique ocular muscle is shown on an 
actual case. 

Routine distribution of all films listed is on a. loan basis. Copies of the 
films are deposited in Training Aids Libraries and are available on request. 
Such requests from shore stations should be addressed to the Senior Medical 
Officer of the cognizant Naval District, Air Training Command, or Potomac 
and Severn River Commands. 

^ 9^ 3): 



- 18 - 



Special Clothing for Naval Personnel : TMb standard special clothing allow- 
ance list for naval personnel has recently been revised by VCNO Serial 6050-A, 
15 Jan 1944, which supersedes VCNO Serial 21511-G, 29 Jul 1943. The special 
clothing list for the various zones consists of the following standard articles: 

I'i'taMoal Zone 



(a) Individual Allowances' (Men) 
1 Jacket, parka, rain 

1 Trousers, Rain N-2 ■ ' 

2 Jackets, Utility N-3 

3 Trousers, Utility N-3 
3 Shirts, Utility N-3 

2 CB^pB, utility N-3 



1 Helmet, Sun N-3 

2 Shoes, Field N-1" 
2 Gloves, Work N-1 

2 Gloves, Mosquito N-2 
1 Glasses, Sun N-1 
1 Bag, ^©eial Glolliiiig 



(b) Individual Allowances CWomen) 

1 Coat, Parka, Rain, Women's WN-2 1 Glasses, Sun N-1 

2 Sho®i, Field, Women WN-1 1 S^lip©!, Bm 

2 Gloves, Mosquito N**! 



(c) Individual Allowances (Men) 
1 Jacket, Parka, Rain N-2 

1 Trousers, Rain N-2 

2 Jackets, Utility N-3 

3 Trousers, Utility N-3 
■ 3 Shirts, Utility N-3 

1 Jacket, Winter N-1 

(c^ Individixal- Allowanees (Wom^n) 

' 1 Coat, Parka, Rain, Women's WN-2 

2 Shoes, Field, Women's WN-1 
1 Arctics, Women's WN-1 

1 JaefetjWIirtQr H-1 ' ■ 



1 Trousers, Winter N-1 

2 Caps, Utility N-3 

1 Arctics, Shore N-2 

2 Shoes, Field H^l- 
2 Gloves, Work N-1 

1 Bag, Special Clothing N-1 



1 Trousers, Winter N-1 
4 Drawers, Winter, Women's WN-1 
4 Undershirts, Winter Women's WN-1 
• g Gloves, Winter, W'03«@l*i WU-l 



Gold Zone 



(e) Individual Allowances (Men) 
1 Jacket, Parka, Rain N-K 
1 Trousers, Rain N-2 •• 
1 Jacket, Winter N-1 
1 Trousers, Winter N-1 
1 Ooat, PirKa, Wtote H-l 
a jackets. Utility N-3 



1 Hfelmet, Wliitisi' 1|**1 

1 Helmet, Winter N-2 

2 Shoes, Field N-1 

1 Arctics, Shore N-2 

I Mittens, Wster|>i*dOf N-1 



- 10 * 



Burned News Letter, Vol, 3, No. 5 fiESTfilCTED 



Cold Zone (cont.) 



(e) Individual Allowances (Men) 

3 Trousers, Utility N-3 

3 Shirts, Utility N-3 
2 Caps, Utility N-3 

(f) Individual Allowances (Women) 

1 Jacket, Winter, Women's WN-1 
1 Trousers, Winter, Women's WN-1 
1 Jacket, Parka, Rain, Women's WN-2 
1 Trousers, Rain, Women's WN-2 
1 Helmet, Winter N-1 
1 Helmet, Winter N-2 

4 Undershirts, Winter, Women's WN-1 

1 Bag, Special 



1 Mittens, Winter N-2 
4 Socks, Winter N-1 

1 Bag, Special Clothing N-1 

4 Drawers, Winter, Wome'n's WN-1 
4 Stockings, Winter, Women's WN-1 
4 Anklets, Winter, Women's WN-1 

2 Shoes, Field, Women's WN-1 

2 Gloves, Winter, Women's WN-1 
1 Arctics, Women's WN-1 
1 Coat, Parka, Winter, Women's WN- 
Clothing N-1 



Arctic Zone 



(g) Individual Allowances (Men) 
1 Jacket, Parka, Rain N-2 
1 Trousers, Rain N-2 
1 Jacket, Winter N-1 
1 Trousers, Winter N-1 
1 Coat, Parka, Winter N-1 
1 Helmet, Winter N-1 
1 Helmet, Winter N-2 

1 Mask, Face, Winter N-1 

2 Shoes, Field, N-1 

1 Arctics, Shore N-2. 
1 Bag, Sleeping N-1 



1 Boots, Sea N-1 

2 Mittens, Work N-3 

1 Mittens, Winter N-2 

1 Mittens, Waterproof N-1 

1 Goggles, N-1 

1 Scarf, Winter N-1 

1 Sweater, Winter N-1 

4 Undershirts, Winter N-1 

4 Drawers, Winter N-1 

4 Socks, Winter N-1 

1 Bag, Special Clothing N-1 



(h) Individual Allowances (Women) 
1 Jacket, Winter, Women's WN-1 
1 Trousers, Winter, Women's "WN-1 
1 Jacket, Parka, Women's Rain WN-2 
1 Trousers, Rain, Women's WN-2 
1 Helmet, Winter N-1 
1 Helmet, Winter N-2 

1 Scarf, Winter N-1 

2 Mittens, Work N-3 

4 Undershirts , Winter, Women's WN- 1 



4 Drawers, Winter, Women's WN-1 
4 Stockings, Winter, Women's WN-1 
4 Anklets, Winter, Women's WN-1 
2 Shoes, Field, Women's WN-1 
2 Gloves, Winter, Women's WN-1 
1 Arctics, Women's WN-1 
1 Coat, Parka, Winter, Women's WN-1 
1 Bag, Special Clothing N-1 
1 Bag, Sleeping N-1 



Such items of clothing as are required by naval personnel may be drawn 
from supply officers assigned to duty with units at overseas bases beyond con- 
tinental limits. 



- 20 - 



Binned News Letter, Vol. 3, No. 5 



The purpose Df prOTMiEg special clothing is to iftgitt© adefaat#'pr^^^ 
mder various climatic conditions to naval personnel assigned to duties involv- 
ing continued or frequent exposure to weather conditions where the standard 
articles of uniform do not provide adequate and suitable protection. Special 
clothing is the property of the gowrmnent, ajld necessary measures steuld be 
taken for its proper care and for its return, when no longer needed, to tte 
supply officer for renovation and reissue. Only those articles which are re- 
quired by local conditions consistent with the duties performed should be requested, 

Tha clothing" prescribed by the ¥CNO iette^K meintlciEiei a- 
study of the climatic conditions in the various areas where the naval persotmel 
may be serving. This letter should be consulted for detailed information. 

The availability of some of the items of cilothlhg may.b^ delayed- for - a ■short 
interval as the volume of production is not yet sufficiently great to create the 
necessary reserve stock. (L.L.A.) 



To: All Ships and Stations. ■ BUMED-X-FEW-IH 

. L8-2/JJ5 7(042-43) 

SubJ: Pewiisffite Thei?apy of Gonococcus 

Infections, Modification of. 23 ^-eb 1944 

Ref; (a) BuMed Ltr of Information and Instruction L8-2/J757(042-43) 
7 Jan-iM4. 

1 . Evidence is conclusive that penicillin has a more rapid and certain thera- 
peutic action in gonococcus infections than have the sulfonamides. 

2; Since the saving of man-days in our fighting forces is of paramount impor- 
tance to the war effort, the use of penicillin in the primary treatment of gono- 
coccus infections, where feasible, is indicated. ■ • 

3. Therefore, in men whose services are urgently needed and where penicillin 
is available in quantities exceeding requirements for the lifesaving therapy of 
acute fulminating infections, the use of penicillin as the primary chemothera- 
peutic agent alon# ojf to comb^atlen with a sulfonamide Is authofijssd for the 
treatment of gonococcus infections. 

4. The above modifies and supersedes the restriction of penicLllin therapy of 
gonococcus infections to those pro:ven sulfa- resistant (i"ef . a). 

"BuMed. Ross T. Mclntire. 



- 21 - 



Burned News Letter, Vol. 3, No, 5 



RKRTRICTED 



To: . All Ships and Stations. Opl3C-jc 

Serial 42513 

Subj: U. S. Naval Medical Research Unit No. 1, S01231 12 

Redesignation of. IV Jan 1944 

1. In order that the designation of the Naval Laboratory Research Unit No. 1, 
Berkeley, California, may more aptly describe its function as an integral organi- 
zation with specially trained personnel and the equipment and supplies necessary 
to operate a medical research laboratory, it is hereby established under a medi- 
cal officer in command and redesignated 

U. S. Naval Medical Research Unit No. 1, Berkeley 4, California. 



This is an activity of the Twelfth Naval District. 

2. Bureaus and offices concerned take necessary action. 

— SecNav. James Forrestal. 

+ 5^: + * * + 



To: All Ships and Stations. ■ Opl3C/whl 

Serial 30713 

Subj: Instructions for Granting Pratique - SOI 26 97 

Ports of Cristobal and Balboa. 29 Jan 1944 

Ref: (a) Ltr from ComPaSeaFron and Com. 15, dated 21 Jan 1944, with 

enclosure. 

1. The following instructions, issued by the Commander Panama Sea Frontier 
and Com. 15 in reference (a), are published for the information and guidance 
of all officers concerned with the routing or sailing of ships to the Canal Zone: 

"Under wartime arrangement between the Commandant and the Governor 
of The Panama Canal, quarantine regulations for ships entering Cristobal and 
Balboa Harbors are supervised and enforced by the District Medical Officer of 
the Fifteenth Naval District for vessels of the U. S. Navy having only Navy and 
Army officers and enlisted personnel aboard. In accordance with this arrange- 
ment, the following instructions will govern: 

"(a) All U. S. Navy ships entering Cristobal or Balboa shall hoist the quaran- 
tine flag upon entering harbor and shall keep the quarantine flag flying until pra- 
tique has been granted. If a U. S. Navy ship enters Cristobal or Balboa not flying 
the quarantine flag, the Harbor Entrance Control Post concerned will instruct 
them to do so. 



- 22 - 



Bttmed News Letter, Vol. 3, No, 5 



HEBTRIOTED 



**{b) U. S. Navy' ships having medical offlc®a7S or piarmaclst^g matgs aboard 
and which are not proceeding 'direct to Naval Station, Coco Solo if arriving from 
sea, shall, upon arrival off Cristobal or Balboa, inform Harbor Entrance Control 
Post, Cristobal or Harbor Entrance Control Post, Balboa as to whether or not 
any commtmicable diseases or ©i^ian passen^rs are on tooard, aaid request 
pratique. If no communicable diseases or civilian passengers are reported, the 
Harbor Entrance Control Post concerned, without reference to higher authority, 
shall signal the ship "PRATIQUE GRANTED X HAUL DOWN QUARANTINE 
FLAd*'. If conimtiniGabte diseases ot ctvlHan passengers are reported onboard, 
the Harbor Entrance Control Post concerned will immediately r^OEt same to 
the Operations Watch Officer who will in turn immediately inform the District 
Medical Officer or officer designated by him who will take necessary action. The 
Harbor Entrance Control Posts will inform the Operations Officer, Panama Sea 
Frontier of such action and will kssep i2i aeeia^e s@cs»d of messages received 
from ships requesting pratique and replies to such requests. The Operations 
Watch Officer will note in his log the receipt of all such messages from the Har- 
bor Entrance Control Posts and his COWO) action. 

**Ca) All ships berthing at Coco Solo after arriving from sea will be visited 
by a medical officer from the Naval Station, Coco Solo, who will grant or refuse 
pratique as the situation warrants. This medical officer will keep a complete 
ree©l*d as to whsA ships have been granted pratique, or in the caae that pratique 
was T&imMi tte cii^ciott^ahc^ suM*oiitiitng game>- . 

*'(d) No personnel from any naval ship shall be permitted ashore or contact 
with the shore until pratique has been granted. 

"(e) The above instructions do not apply to ships assigned Panama Sea 
Frontier which have proceeded to sea from the Canal Zone and have not touched 
port during their absence from the Canal gone. These instructions do apply to 
sMpa assigned to the Panama Sea Frontier if, dmring their absence from the 
Canal Zone, they have touched port, except in the Republic of Panama.^ 

"(f) In the case of two or more U. S. Navy ships in company, the Task 
Force, droup or Unit Commander or the Senior Officer of the group may make 
the repoft and request for pratique required by paragraph (b) for the U. S. Navy 
ships in company. When this is done it is incumbent upon the Harbor Entrance 
Control Posts to record the names of all ships included in such request. 

"(g) Attention is invited to the fact that these instructions do not apply to 
merchant ships or ships with civilian crews although carrying U. S. troops. 
The granting of pratique for such ships is strictly a function of the Chief Quar- 
anttn^-mdfcspeetion 0tec©r of the Panama =Ganal." --OpNav. W. S. Farber. 



- 23 - 



Burned News Letter, Vol. 3, No. 5 



RESTRICTED 



To: All Ships and Stations. BuMed:R3:]NR 

P3-5/P19-1C034) 

Subj: Damaged Health Records, Disposition of. 18 Jan 1944 

Ref: (a) Paragraph 2210, Manual of the Medical Department. 

1. The Bureau has received a number of requests for information as to what 
disposition should be made of health records which have become covered with 
oil, watersoaked, or otherwise damaged to such an extent as to impair their 
legibility and value as a permanent record. 

2. Such records should be replaced by duplicate records. The duplicate should, 
as nearly as may be practicable, be an exact copy of the original record. It is 
particularly important that the data on the descriptive sheet (Form H-2) be care- 
fully transcribed into the new record as the information contained on this sheet 
may be required by the Veterans' Administration to determine the individual's 
rights to pension or other Federal Benefits. 

3. The new health record should be stamped or marked ''Duplicate" on the 
cover, and the circumstances necessitating the preparation of the duplicate 
record explained in a note on a medical history sheet. 

4. Health records which have been replaced by duplicate records should befor- 
warded to the Bureau for file with a letter of trsinsmittal making reference to 
this letter. 

5. Instructions for replacing health records that have been lost are contained 

in reference (a) . --BuMed. Ross T.McIntire. 

If: ^ :f: ^ 

To: All Ships and Stations. , BuMed:Rl:JLA 

P3-5/P19-1C034) 

Subj: Health Records, Disposition of. • 22 Jan 1944 

Ref: (a) Paragraphs 2202 (c),Cd3, (e); 2205 Cc) and 2206 (d), Manual of 

the Medical Department. 

Cb) BuMed Itr P3-5/P19-1C034), R-VC, dated 30 Mar 1943. 

1. The health records of persons who have been discharged from the service or 
whose service has been terminated by reason of resignation, retirement, deser- 
tion, or death should be promptly closed out and forwarded to the Bureau with- 
out delay. These records are essential in the settlement of claims for pensions 
and other benefits submitted to the Veterajis' Administration. Attention is in- 
vited to the instructions in references (a) and Cb) . 



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Burned News Letter, 'Vol. 3,.H6.-& RESTEIGTED 



Medical t>6pM*tm€rrt; tr.B.W.:, are' belag -jni^Hitedr'feir ^strfetttfeffi to feMsrs^bf ^ , '■ 
the manual for insertion therein. Upon receipt of revised letter, the old letter 
effective as of July 1939 will be discontinued and appropriate change noted on 
"Table of Contents/' Appendix D, Circular Letter I. . : 

2. In order to facilitate the mailing of the subject revised letter, the senior 
officers of activities are directed to determine the number of both office and 
personal copies of the Manual of the Medical Department, U.S.N. , that are on 
hand, and forward requests to BuMed for the corresponding number of copies 
required" of ■ Subject letter. Beproduetion of subject Circular Letter I, Appen- 
dix D, follows: •■ ■ •' ■ ■ • : . 

BUREAU CIRCULAR LETTER I 

Subject: Weekly Report of Patients in Naval Hospitals, Bed Capacity, Distri- 
butioh, and Certain Classifications - NavMed I <3419, 3553, 3555). - 

(a) INSTRUCTIONS FOR LETTERED COLUMNS. • • • 

Column A, ■ Remaining Last- Repport. - Enter number of -patients as ifrdlcated 
on form; entries under Remaining Last Report must -agree -with those reported 
as Remaining This Report on previous week. 

Column B. Admitted During Week. - Enter number of patients actually ad- 
mitted during week endifltg Wednesday at midnight, as indicated- on reiJ'ortv'; ' -■--■ 
■*'Others" (under supernumeraries) should include retired officers and enlisted 
men, and patients not specified in listing. 

Column C. Discharged During Week. - Enter number of patients actually 
discharged during the week. 

Column D. Reteiaining This Report. - The total remaining must represent 
the entire number of patients carried on the sick list and under treatment on the 
date of the report, and must agree with the total of Beds Occupied in column F. 

Column E. Existing Bed Capacities on 8- Ft. Centers. - The number report- 
ed in this column is the bed capacity based on 8-foot centers and is subdivided " 
into beds allocated to officers, to enlisted men, and to enlisted women. 

Column F. Beds Occupied. - The total figure of beds occupied, subdivided 
as officers on active duty, enlisted men on active duty, enlisted women on active 
duty, and all classes of supernumerary patients, must e^fiial the Total Remtlft- 
ing in column D. All patients who are carried on the sick list and under treat- 
ment but are subsisted at home, must be included in the number of Beds Occupied 
of column F under the appropriate heading. Hospital ships will report only ac- 
commodations for patients in this column. 

Column G. Classification of Veterans' Administration Patients Remaining. 
In order to compile a special report for the Director of the Veterans' Adminis- 
tration, patients who are beneficiaries under that administration will be classed 
as to number in this column as provided Under the headings, Tuberculous, Psy- 
chotic, Other N. P., and GenaraL Total of this grouping must equal the-number 
reported as Veterans' Administration in Column D. ' " ' 



Burned News Letter, Vol. 3, No. 5 RESTRICTED 



2. It is also requested that all medical-department activities be directed to 
check the health records on hand and forward to this Bureau any health records 
on file of persons who have been separated from the service or detached from 
the ship or station and whose present station of duty cannot be determined. 

— Bumed. Ross T. Mclntire. 



To: Ail Ships and Stations, BuMed:Rl:]LA 

P2-3(084-42) 

Subj: Prescriptions for Spectacle Lenses to be 24 Jan 1944 

Entered in Health Record. 

Ref: (a) BuMed Itr of 5 Oct 1943; N.D. Bui. of 15 Oct 1943, R-1485. 

1. It is directed that whenever lenses are prescribed for correction of visual 
defects by a medical officer, the prescription be entered in the health record 
on Form H- 3(1 940) in the space provided for refractions in the special duty 
abstract. In the event Form H- 3(1 940) is not contained in the health record 
of a man for whom lenses have been prescribed, a copy of the prescription 
shall be entered on the medical- history sheet. Prescriptions obtained from 
other than naval sources which provide satisfactory correction should be simi- 
larly recorded when practical. 

2. It is desirable that the man concerned be furnished a copy of the prescrip- 
tion and that he be advised to carry it with him. 

3. Copies of the recorded lens prescription should be furnished mobile opti- 
cal units if practical in the event manufacture of new lenses is necessary. 

--BuMed. Ross T. Mclntire. 



To: All Ships and Stations. * BuMed: Y;VS 

A3-3/A9-6(122-42) 

Subj: Weekly Hospital Report of Patients, NavMed I 27 Jan 1944 

(3419, 3653, 3555). Circular Letter I, Appen- _ ■ " 

dix D, Manual of the Medical Department, U.S.N. - 
Revision of. Effective at Once, 

Ref: (a) Weekly Report of Patients in Naval Hospitals, Bed Capacity, 

Distribution, and Certain Classifications - Form I, Manual of the 
Medical Department, II.S,N., paragraphs 3419, 3553, and 3555. 

1. The subject letter, and form (a), have been revised, and as reproduced herein 
are effective at once. Copies of revised Circular Letter I, Appendix D, Manual 



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Burned News Letter, Vol. 3, No. 5 



Column H. Summary of Communicable Diseases. - List in summary form 
the number of patients (active -duty personnel) remaining on date of the report 
for each of the diagnoses included in classes VIII-IX-X-XIII, Navy Nomencla- 
ture. 

Cb) INSTRUCTIONS FOR NUMBERED COLUMNS.- 

Columns 1 and 2. - Enter the names and rank of all patients who are officers 
(Navy and Marine) on active duty, nurses, midshipmen, or Naval Reserve officers 
on active duty who have been admitted or discharged during the period of the re- 
port, or whose diagnosis has been established or changed in any way. 

Column 3. - Use terms of Navy nomenclature and enter diagnosis and key 
letter under which patient was received as a transfer; or if established or changed, 
enter accordingly. 

Colimin 4. - Enter name of place from which patient was received; if estab- 
lished or changed, enter words CHANGE OF DIAGNOSIS or ESTABLISHED, as 
case may be. 

Column 5. - Enter date, expressed in figures, taken up as a readmission, 
diagnosis established, or change of diagnosis. " ■ 

Column 6. - Enter date of disposition expressed in figures. 
Column 7. - For Bureau use, express condition as follows; 
C - Convalescent. 

F - Favorable. • ' 

. U - Unfavorable, 
S - Serious. 

Column 8. - Enter date patient is considered as available for duty. Incase 
of actual discharge from the sick list as D, DD, IS, Ran, or T, so indicate. If 
T (transfer), state place to which transferred as a patient. 

3. It will be noted that all on page 2 after column 8 has been deleted. 

+ + 



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Burned News Letter, Vol. 3, No. 5 RESTRICTED 



NAVMED I 
(Revised 1943) 

WEEKLY HOSPITAL -REPORT OF PATIENTS 
To the Bureau of Medicine and Surgery 

U. S Date 

(Name and location of hospital or hospital ship) (For week ending Wednesday) 

Forwarded (MC) , U. S. N. 

(Signature) 



Patients 

Active Duty 

Supernumeraries- - 

Vet. Administration 

Emp. Comp. Comm. 

Pensioners 

Others 

TOTAL 



: Remaining : Admitted : Discharged : Remaining 
: Last Report : During Week : During Week : This Report 
J m ; fB) ! (C) : (D) 



""■*"•*«* «... ...«.....» ...» ' - 



Existing Bed Capacities 
on 8-Foot Centers 

(E) 



Beds Occupied 



Classification of 
Veterans' Administration 

Patients Remaining 
(G) 



Officers 

Enlisted men . . 
Enlisted women. 

TOTAL t._ ■> ■ 



Officers. .... 
Enlisted men 

Enlisted women 

Supernumeraries 

TOTAL t.--n •j.i. 



Tuberculous .. 
Psychotic. . . . 
Other N. P.. . . 

GeneraL 

TOTAL 



(H) Summary of Communicable Diseases--(List by Diagnosis - Class vm-IX-X-XIID; 

(LIST PATIENTS ON REVERSE) 



NAVMED I . Sheet No.. 

WEEKLY HOSPITAL REPORT OF PATIENTS— FOLLOWING SHEET 



Name : Rank 
(1) : (2) 


Diagnosis 
(3) 


Patient 
Received ■ 
From : 
(4) • 


Date 
Admit- 
ted 
(5) 


Date 
Dis- 
charged 
(6) 


Condi- 
tion 

(7) 


. Probable 
Date Fit 
for Duty 
(8) 

















--BuMed. Ross T. Mclntire. 



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